Reeling Republicans take one last shot at Obamacare

Twenty-three years ago, President Bill Clinton and Senate Democrats canceled two weeks of the August recess to pass a major health care bill. They got nowhere.

Now Senate Majority Leader Mitch McConnell is trying the same thing with the GOP for the August break, and it may lead to the same result.

“I’m hoping for better this time,” said Sen. Chuck Grassley (R-Iowa) on Tuesday afternoon after saying earlier he was “very pessimistic” the GOP would succeed. In 1994, Democrats “kept us in and we didn’t accomplish anything.”

In fact, McConnell would like to finish health care well before August. Though he pulled a vote in June, Republicans say they are serious about completing their work in the coming days.

There will be a vote to advance the bill next week, McConnell said Tuesday. And even if it fails, he made clear to his members at a party lunch that there will be no more false starts despite an increasingly downbeat feeling in the caucus.

New text of the proposal will be made public Thursday, and a Congressional Budget Office analysis is expected on Monday.

“We’re in gridlock,” said Sen. John McCain of Arizona. He added sarcastically: “Now we’re going to look at a new approach. And we’re going to get a CBO estimate on Monday. Yay!”

Sen. Ron Johnson, a conservative holdout, called it a “political blunder” that McConnell started the health care debate as a partisan, all-Republican effort.

“It’s just not smart politically,” the Wisconsin senator said.

McConnell spoke to President Donald Trump over the weekend about health care, a source familiar with the conversation said. The White House is distracted by Donald Trump’s Jr.’s deepening Russia scandal but Trump “definitely wants [health care] done,” the source said.

McConnell’s new timetable comes as his party is mired in a tug of war among its ideological factions and clearly lacking the 50 required votes to even advance the bill.

An amendment written by Sens. Ted Cruz of Texas and Mike Lee of Utah is fracturing the conference, with the measure taking center stage at the party’s first caucus lunch in nearly two weeks on Tuesday. Though the proposal to allow the sale of cheap, deregulated insurance plans is championed by the right, other Republicans say it would undermine their promise to keep Obamacare’s protections for people with pre-existing conditions.

There will be two drafts of the new bill text and two scores, senators said: One with the amendment, the other without. McConnell and his team have not decided whether the divisive measure will be included in the base bill. That decision will determine whether Cruz, Lee and other reluctant Republicans even vote to open debate on the bill.

McConnell is urging senators to use the bill’s open amendment process to alter the measure to suit their concerns, according to senators and aides.

“I just can’t imagine not voting to proceed to the bill when you’ve got an open amendment process,” said Sen. Bob Corker of Tennessee. “If you don’t like what ends up happening, you can vote no, can you not?”

But many senators suspect McConnell will introduce a substitute measure at the end of the amendment blitz next week that would overwrite any alterations during the bill’s “vote-a-rama.” And GOP leaders believe if the debate begins, the vote would pass.

If they start the debate “that will mean I’m confident that we will get there before it’s over,” said Senate Majority Whip John Cornyn of Texas.

Republicans were told on Tuesday the latest draft is likely to keep some of Obamacare’s taxes on the wealthy and Medicare to help lower premiums for people with low incomes, provide $45 billion to fight opioid addiction and allow people to pay premiums with pre-tax money. It does not appear there is yet a solution for moderates and people from Medicaid expansion states, many of whom gathered on Tuesday to strategize.

“I’m not optimistic that it’s going to be a bill that I can support. But obviously I’ll withhold judgment until I see it. It sounds to me like it does not make a lot of major changes,” said Sen. Susan Collins of Maine. The moderate senator is concerned that future spending reductions to Medicaid would cripple rural hospitals in her state.

Sen. Rand Paul, one of the GOP’s most vocal opponents from the right, said he hasn’t heard anything that would change his position, even if the amendment by Cruz and Lee is attached.

“I promised to repeal it,” the Kentucky lawmaker said of Obamacare. “I didn’t promise to permanently codify that the federal government will buy peoples’ insurance, subsidize their insurance and then throw a big pool of money at the insurance companies.”

The GOP strategy to pass the bill, he said, is “the kitchen sink right now — they’re just throwing more money at everything.”

Indeed, deal-seeking Sen. Lindsey Graham (R-S.C.) said he was convening a group of senators to write a new bill to replace Obamacare. It’s not clear how Graham’s plan would align with McConnell’s work, though he said he believed he could get the support of some Democrats.

That could be helpful, considering how divided the Republican conference is over the issue.

The Cruz and Lee amendment lacks support, and its future has been complicated by a game of telephone between GOP leaders and the two conservative senators. After much back and forth among McConnell, the two conservative senators and CBO, the amendment was rewritten again Monday, two sources said.

Republicans have asked CBO to analyze two versions of their bill, according to senators: one with the Lee and Cruz amendment and one without the provision. The dual scores could set up a showdown between the Senate’s conservative standard-bearers and other Republicans.

It is unclear whether the CBO score for the Cruz and Lee proposal will be ready in time for next week’s vote on starting debate on the bill.

Republican senators and aides were expected to meet with the Senate parliamentarian on Tuesday about what health care reforms the Senate rules allow. But the Cruz and Lee proposal doesn’t have 50 Republican votes at the moment to survive, senators said.

“They have an amendment that I have no objection to,” said one Republican senator, before adding, “I don’t think they have the votes to keep it.”

Cruz and Sen. Lamar Alexander (R-Tenn.) met for a private breakfast on Tuesday. The two started the Senate’s working group on health care several months ago and disagree on the effectiveness of Cruz and Lee’s amendment.

Critics say that bifurcating the insurance markets will result in healthy people buying deregulated insurance and sick people buying insurance under Obamacare regulations, creating a large and costly risk pool of people with pre-existing conditions.

“There’s been a good deal of discussion” about the amendment and potential changes to it, Alexander said. “We’re still discussing it.”

More moderate GOP senators are hoping the measure can be altered to win support of the conference rather than divide it. Some Republicans want to see the risk pools for healthy and sicker people linked in some way so that it prevents sick people from seeing their premiums spike.

The hope is that the amendment “still lowers premiums here but doesn’t create this kind of death spiral over there,” said Sen. Bill Cassidy of Louisiana, who said he has spoken with Cruz about the idea.